WSU REPOSITORY MSN/DNP Enhancing Competence in Assessing Acute Pressure Injuries in Dark-Complected Patients: The Impact of Pre-Assessment Surveys and Targeted Education in Healthcare Provider Education Project Title by Ashley Jonas BSN, RN, MSN Student Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY Ogden, UT April 26th, 2024 Date BSN, RN, MSN Student Student Name, Credentials (electronic signature) 4/26/2024 Date Trish Gibbs DNP, RN, CNE 4/26/2024 MSN Project Faculty Date (electronic signature) 4/26/2024 (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 1 Enhancing Competence in Assessing Acute Pressure Injuries in Dark-Complected Patients: The Impact of Pre-Assessment Surveys and Targeted Education in Healthcare Provider Education Ashley Jonas, BSN, RN, MSN Student Annie Taylor Dee School of Nursing Weber State University MSN Project 2 Abstract Purpose/Aims: This project aims to enhance competence in pressure injury assessment for darkcomplected patients among healthcare provider students through targeted surveys and education. Rationale/Background: The project addresses disparities in healthcare delivery for diverse patient populations identified through a comprehensive literature review. It highlights the impact of structural racism, which causes healthcare disparities, and the need to improve cultural competence and education in pressure injury assessment. Methods: By utilizing evidence-based approaches, the project develops educational materials and strategies tailored to the specific needs of dark-complected patients. These include interactive learning activities and multimedia resources. Evaluation methods include pre- and post-assessment surveys and longitudinal follow-up assessments. Results: Preliminary results indicate improved competence and preparedness among healthcare provider students in pressure injury assessment for dark-complected patients. Conclusions: The project contributes to advancing nursing practice by promoting culturally sensitive care and addressing healthcare disparities in pressure injury assessment. Future efforts will focus on collaboration with stakeholders and further research to explore barriers to pressure injury assessment and evaluate patient outcomes. Keywords: pressure injury assessment, dark-complected patients, cultural competence, healthcare disparities, healthcare education. 3 Enhancing Competence in Assessing Acute Pressure Injuries in Dark-Complected Patients: The Impact of Pre-Assessment Surveys and Targeted Education in Healthcare Provider Education This research paper explores the impact of implementing targeted education related to assessing and identifying pressure injuries in dark complexions. The program evaluates the baseline competence of healthcare providers in identifying acute pressure injuries in darkcomplected patients before and after introducing a teaching module. This study aims to investigate whether integrating pre-assessment tools and specific education can enhance the proficiency of clinicians in assessing pressure injuries in patients with dark skin tones compared to those who do not receive such pre-assessment or targeted education. Issue Statement Pressure injuries, also known as pressure ulcers or bedsores, are a significant healthcare concern, affecting patients across various settings. These injuries result from prolonged pressure on the skin, often associated with immobility, and can lead to severe complications. Darkcomplected patients are at a higher risk of acute pressure injury presentation (Harms et al., 2014). Healthcare providers may face challenges in identifying these injuries due to the potential difficulty in recognizing skin changes in darker skin tones due to a lack of education regarding injury presentation (Shanmugavadivel et al., 2022). Previous research has highlighted the disparities in assessing pressure injuries in patients with dark skin tones, emphasizing the need for specific training and education for healthcare providers (Oozageer et al., 2020). However, more focus should be on the effectiveness of preassessment surveys and targeted education in improving competence among nursing and nursing assistant students. 4 Significance and Purpose This project addresses a significant gap in healthcare education related to pressure injury assessment in dark-complected patients. In healthcare, accurate assessment and early detection of pressure injuries are crucial to prevent complications and improve patient outcomes. The pressure ulcer rate among admissions to medical facilities in patients with dark complexions was 1.7 times higher than those with light complexions (Harms et al., 2014). This statistic is often due to systemic racism and implicit bias in healthcare, which creates a lack of education regarding pressure injury signs and symptoms in dark complexions, as they present differently than in light complexions. Interventions aimed at racial bias and lack of education will improve the rate of disparities for people of color (Hall et al., 2015). This project seeks to determine whether implementing a pre-assessment survey and targeted education can increase competence among nursing and nursing assistant students in assessing pressure injuries in dark-skinned individuals, thereby reducing healthcare disparities and improving patient care. Rationale The need for this study arises from the limited emphasis on pressure injury assessment in dark-complected patients within healthcare provider education. Existing literature indicates a knowledge and competence gap, leading to disparities in patient care outcomes (Sullivan, 2014). This study aimed to address this gap and evaluate the impact on healthcare provider students' competence in assessing acute pressure injuries in dark-complected patients by implementing pre-assessment surveys and targeted education. Review of the Literature and Framework 5 The Literature Review section of this paper aims to focus on the existing gaps in literature and educational resources concerning the accurate assessment of skin conditions in individuals with dark complexions. This literature review aims to explore the absence of literature in this critical area, understand the importance of addressing this gap, and identify the barriers that have hindered the development of educational materials for healthcare professionals. In dermatological assessments, individuals with dark complexions face unique challenges that lead to poorer health outcomes (Pusey-Reid, 2023). Skin conditions manifest differently in darker skin tones, making accurate assessment essential for effective diagnosis and treatment (Steven et al., 2015). This review considers a framework that highlights the need for comprehensive educational materials and resources tailored to healthcare professionals to improve their ability to identify dermatological conditions in individuals with dark complexions. Framework For this project to focus on enhancing competence in assessing pressure injuries in darkskinned individuals among nursing and nursing assistant students, it is essential to choose an Evidence-Based Practice (EBP) change model that guides the implementation process effectively. The large number of change models can make the implementation process difficult because it can complicate determining the best tool for healthcare organizations (Dusin et al., 2023). Many models and frameworks have assessed the characteristics and gaps that can better assist healthcare organizations in determining the best model to examine the issue. For this project, the Stetler Model for Evidence-Based Practice is appropriate. The Stetler Model consists of five phases: 6 1. Preparation Phase: In this phase, a team of experts and stakeholders will be assembled to contribute to the project. This team will assess the current evidence and identify the gap in knowledge and practice regarding pressure injuries in dark-skinned individuals. 2. Validation Phase: During this phase, the team will critically appraise and evaluate the existing evidence to determine its relevance and applicability to the project's goals. This step ensures that the chosen interventions are supported by high-quality evidence. 3. Synthesis Phase: The team will synthesize the evidence to develop a specific plan for implementing the pre-assessment survey and targeted education. This phase includes developing protocols and guidelines for the education program. 4. Implementation Phase: This is where the actual implementation of the pre-assessment survey and targeted education takes place. The team will work on disseminating the education to nursing and nursing assistant students and integrating the pre-assessment survey into their practice. 5. Evaluation Phase: The project will be evaluated to determine its effectiveness. The team will assess whether implementing the survey and education has indeed increased competence among the students and positively impacted reducing healthcare disparities in pressure injury assessment for dark-skinned individuals. Applying the Stetler Model to this project is highly relevant, providing a structured approach to incorporate evidence-based changes into practice systematically. This model ensures that the project is grounded in evidence, involves key stakeholders, and systematically evaluates the outcomes (Stetler, 2001). By following these phases, specific objectives of the project can be addressed, ultimately contributing to reducing healthcare disparities and improving patient care in assessing pressure injuries in dark-skinned individuals. 7 Strengths and Limitations The Stetler Model for Evidence-Based Practice offers several noteworthy strengths and limitations that warrant consideration, both in general and when applied to this project. One of its notable strengths is its structured approach, providing a systematic framework for evidencebased practice. This structured framework encompasses all essential steps, from preparation to evaluation (Titler et al., 2001). This approach is instrumental in guiding projects effectively and ensuring the omission of non-critical steps. The Stetler Model promotes interdisciplinary collaboration, encouraging the engagement of various subject experts and stakeholders. This collaborative approach enhances the quality of evidence synthesis and the development of interventions (Melnyk et al., 2012). In the context of this project, involving stakeholders and experts in pressure injury assessment is likely to result in more comprehensive and effective interventions. The model also strongly emphasizes the evaluation phase, underscoring the importance of thoroughly assessing the effectiveness of implemented changes (Rycroft-Malone et al., 2004). The evaluation phase emphasizes the project's overarching goal of determining whether the pre-assessment survey and targeted education effectively increase student competence in assessing pressure injuries. When considering the implementation of the Stetler Model in the project, it is crucial to acknowledge its strengths and limitations. The model's resource-intensive nature, demanding significant time, personnel, and access to relevant literature, can present challenges regarding project feasibility and resource allocation (Melnyk et al., 2012). Additionally, its five-phase structure may be perceived as complex, possibly leading to implementation difficulties, underscoring the importance of a clear plan and dedicated team members (Titler et al., 2001). The thoroughness of this model, while ensuring comprehensive, evidence-based practice, could 8 cause delays in implementation, which could be problematic in situations requiring timely interventions (Rycroft-Malone et al., 2004). To avoid this, a careful balance between the need for thoroughness and project timelines is essential. In the context of this project, the Stetler Model's strengths align well with the project’s goals, facilitating the systematic implementation of the pre-assessment survey and targeted education. The involvement of relevant stakeholders and a commitment to a thorough evaluation will help assess skin assessment competence improvement among students. It is also vital to remain mindful of the model's resource-intensive nature and the potential for delays, as these factors can impact the overall timeline and feasibility of the project. 9 Analysis of Literature The process of conducting a literature review highlights the pressing need to close the knowledge gap and improve education regarding proper skin assessments for individuals with darker complexions. Three reoccurring themes were found which support the MSN project PICOT question: In healthcare provider education, will the implementation of a pre-assessment survey and targeted education regarding pressure injury in dark complexions improve competence in assessment for acute pressure injuries in dark-complected patients after introducing a teaching module, as compared to healthcare provider students who receive no preassessment or targeted education on this topic? The first theme discovered was the lack of comprehensive research and educational resources, which poses a significant barrier to equitable healthcare delivery, perpetuating health disparities within the population (Sullivan, 2014). The second theme discovered was the amount of educational deficiencies and health disparities regarding skin assessments in dark complexions (Oozageer Gunowa et al.,2018; Pusey-Reid et al., 2023; Tadesse et al., 2023). The third theme found in the research was barriers to education and standardization of skin assessments (Oozageer Gunowa et al., 2020; Tadesse et al., 2023). Search Methods A systematic search was conducted across reputable academic databases, including Google Scholar, Weber State University's Stewart Library's OneSearch and Advanced Search, and CINAHL. PubMed, CINAHL, and PsycINFO were also used to identify relevant studies and literature published in the past decade. The search utilized a combination of keywords and medical subject headings related to skin assessments, dermatological conditions, dark complexions, and healthcare education. Inclusion criteria encompassed peer-reviewed research articles, systematic reviews, and meta-analyses, all written in English, explicitly focusing on skin 10 assessments in individuals with dark complexions. Various Boolean combinations were created with the abovementioned keywords to create a broad search. Lack of Comprehensive Research on Skin Assessments The research discovered that the first theme that emerges from the literature is the conspicuous lack of comprehensive research dedicated to dermatological assessments in individuals with dark complexions (Sullivan, 2014; Perlman et al.,2020; Shanmugavadivel et al., 2022). The available literature predominantly focuses on dermatological conditions in individuals with lighter skin tones, leaving a substantial knowledge gap regarding the manifestations and diagnosis of skin conditions in dark complexions. Sullivan (2014) conducted a retrospective study on the descriptors associated with identifying pressure injuries in individuals with darkly pigmented skin. While the study provides insights into pressure injuries, it underscores limited research in dermatological assessments for dark complexions. Perlman et al. (2020) explored racial disparities in dermatology training, emphasizing the impact on black patients. This source highlights the need for more diversity in dermatological research and training, which contributes to the insufficient knowledge base in assessing skin conditions in darker skin tones. Shanmugavadivel et al. (2022) assessed healthcare professionals' identification of pediatric dermatological conditions in dark complexions. While the study focuses on the professionals' ability, it indirectly underscores the need for more research and educational resources in this domain. These sources collectively reveal the deficiency in research efforts concerning skin assessments in dark complexions. This issue is a significant concern given the potential disparities in healthcare outcomes for individuals with darker skin tones. Educational Deficiency and Health Disparities 11 The second overarching theme concerns the educational deficiency in healthcare curricula and its implications for health disparities. Healthcare education programs generally need more substantial content on assessing skin conditions in individuals with dark complexions. This deficiency affects healthcare professionals' proficiency in recognizing and diagnosing dermatological issues in this population and contributes to health disparities. Several sources highlight this theme. Pusey-Reid et al. (2023) research on skin assessment in patients with dark skin tone highlighted the need for more educational emphasis on dark complexions. The source emphasizes the need for educational reform to address this deficiency. Oozageer Gunowa et al. (2018) explored pressure injuries in people with darker skin tones in a literature review. While discussing the challenges of assessing pressure injuries, the review indirectly underscores inadequate education regarding skin assessments in dark complexions. Using machine or AI learning, Tadesse et al. (2023) introduced the Skin Tone Analysis for Representation in Educational Materials (STAR-ED). This innovative approach scanned educational literature, recognized the educational gap regarding complexion in healthcare-related textbooks, and aimed to rectify it by enhancing skin tone representation in educational materials. These sources highlight the educational deficiency as a significant barrier to accurate dermatological assessments in dark complexions, potentially leading to delayed diagnoses and health disparities. Barriers to Education and Standardization The third theme revolves around the barriers hindering the development of educational resources and standardized assessment tools for skin assessments in individuals with dark complexions. These barriers encompass resource constraints, limited awareness of the problem, and the absence of standardized assessment protocols explicitly designed for dark complexions. Some resources can be found, such as Mind the Gap (Mukwende et al., 2020), a book written by 12 medical students to address some of these issues, but accessibility is still an issue. Several sources illuminate this theme. Oozageer Gunowa et al. (2020) focus on embedding skin tone diversity into undergraduate nurse education, emphasizing the challenges in educating healthcare professionals regarding dermatological assessments in dark complexions. Steven et al. (2015) delve into recognizing pressure injuries in darkly pigmented skin types, revealing the practical challenges healthcare professionals face in identifying skin conditions in darker skin tones. Tadesse et al. (2023) discuss the need for machine learning-based solutions to address the deficiency in educational materials, highlighting the absence of standardized resources. These sources collectively emphasize the barriers that hinder both the development of educational resources and the establishment of standardized assessment tools for skin assessments in dark complexions. Literature Review Summary and Project Application This literature analysis supports the critical need to address the limited research and educational deficiencies in skin assessments for individuals with dark complexions. The absence of comprehensive research, inadequate educational content, and barriers to education and standardization all contribute to health disparities and pose significant challenges to equitable healthcare. Recognizing and rectifying these gaps in knowledge and practice is essential to ensure accurate dermatological assessments and improved healthcare outcomes for individuals with darker skin tones. The literature analyzed supports the idea of providing medical providers with education regarding proper assessments of different skin tones and how this education can greatly improve healthcare outcomes in those with dark complexions. This particular project will use this 13 information to create proper education for medical providers and assess their knowledge after this education is implemented. Project Plan and Implementation This section will outline the project plan and implementation strategy for addressing the knowledge deficit in healthcare provider education regarding pressure injury recognition in dark complexions. This study aims to assess the impact of introducing a teaching module on the competence of healthcare provider students in assessing acute pressure injuries in darkcomplected patients. The study will employ a pre-assessment and a post-assessment survey to measure any improvements in competence resulting from the educational intervention. This plan is designed to provide a framework for the change process and the implementation of the educational intervention within an institution. The first step of our implementation plan is creating and administering a pre-assessment survey. This survey will be designed to gather baseline data on healthcare provider students' knowledge, skills, and confidence levels regarding assessing pressure injuries in darkcomplected patients. It will include questions about their familiarity with the topic, challenges faced, and current practices. Following the pre-assessment survey, the targeted education phase will commence. The educational content will be carefully designed based on evidence-based literature and guidelines. It will include both theoretical knowledge and practical skills related to assessing pressure injuries in individuals with dark complexions. The educational module will be delivered through various mediums, including lectures, workshops, case studies, and hands-on training sessions. Once the targeted education is completed, a post-assessment survey will be administered to the same group of healthcare provider students. This survey will mirror the pre-assessment 14 survey and will be used to evaluate any changes in knowledge, skills, and confidence levels after the educational intervention. The data collected will be analyzed to determine the effectiveness of the teaching module in improving competence in assessing acute pressure injuries in darkcomplected patients. Following the post-assessment, the project team will analyze the results in depth. Any areas of improvement or further educational needs identified will be addressed through ongoing support and training. This project plan acknowledges the importance of continuous improvement and the need for ongoing education to ensure that healthcare provider students remain competent in this critical aspect of patient care. Plan and Implementation Process The project will be implemented in an educational healthcare institution, specifically within the context of an undergraduate nursing program. The intended recipients of the project include undergraduate nursing and medical students or any medical professional, which could include skin assessments. These students represent diverse individuals seeking to enhance their knowledge and competence in various healthcare fields. In future projects, current nurses, doctors, and medical professionals could also participate in this study in a hospital setting as continuing education. Interdisciplinary Team For the successful implementation of the project, an interdisciplinary team comprising various healthcare professionals will play a crucial role. This team will consist of: Nursing Educators Experienced nursing educators will design and deliver the targeted education module. They will provide expertise in curriculum development, teaching methodologies, and nursing practice. 15 Clinical Instructors These professionals will bring practical clinical experience to the project. They will assist in the hands-on training sessions and provide insights into the real-world application of pressure injury assessments. Physicians Collaborating with physicians will provide medical knowledge and insights into pressure injury assessment from a medical perspective. Their expertise will complement the nursing aspect of the project. Dermatologists Collaborating with dermatologists will provide specialized knowledge regarding skin conditions, especially in individuals with dark complexions. Their expertise will ensure that the educational content is accurate and up-to-date. Cultural Competency Experts Given the cultural sensitivity required in healthcare, experts in cultural competency will be consulted to ensure that the educational content is respectful and considerate of diverse patient populations. The interdisciplinary teamwork involved in this project will profoundly impact patient care and outcomes in several ways. The collaboration between nurse educators, clinical instructors, physicians, dermatologists, and cultural competency experts will result in a wellrounded educational module covering theoretical and practical skills. This comprehensive approach will equip undergraduate nursing and medical students with the competence to assess acute pressure injuries in dark-complected patients accurately. 16 Teamwork will also encourage real-world application. Clinical instructors, physicians, and dermatologists will bridge the gap between theory and practice by sharing their practical experiences and medical perspectives. This will enable students to apply their knowledge effectively in clinical settings, ultimately improving patient care. The project ensures that the educational content considers the unique challenges and needs of patients with dark complexions by involving dermatologists and cultural competency experts. This integrated expertise will lead to more culturally sensitive and effective patient care. The project promotes interprofessional collaboration and communication by bringing together nursing and medical students. This prepares students for future healthcare settings where teamwork and cooperation among healthcare professionals are essential. The interdisciplinary teamwork involving nurse educators, clinical instructors, physicians, dermatologists, and cultural competency experts is essential for the successful implementation of the project. This collaborative effort will not only enhance the competence of undergraduate nursing and medical students. However, it will also positively impact patient care and outcomes by ensuring that pressure injury assessments in dark-complected patients are accurate, culturally sensitive, and aligned with best healthcare practices. Description and Development of Project Deliverables Three deliverables will be presented for the implementation of this project: a preassessment survey, a learning module, and a post-assessment survey. Pre-Assessment Survey The pre-assessment survey will be presented to gauge the baseline knowledge of healthcare provider students regarding pressure injury assessment in dark complexions (Shanmugavadivel et al., 2022). The quiz will be designed to identify areas of weakness and the 17 need for targeted education and include questions regarding risk factors, identification, and assessment. The assessment will be presented as an e-module (see Appendix A). Teaching Module The teaching module will include comprehensive lessons, including structured lessons on pressure injury assessment in dark complexions. It will be completed as an online module. The module will cover topics such as identifying and classifying skin injuries, proper skin assessment, and risk factors, focusing on the challenges faced by dark-complected patients (Harms et al., 2014). The lessons will be divided into manageable sections, each with clear learning objectives (see Appendix B). Post-Assessment Survey The post-assessment survey will be taken after the teaching module. It will attempt to assess the knowledge gained by the students during the learning module by healthcare provider students. The survey will include questions related to pressure injury assessment in dark complexions, content regarding the reason for this education, and risks involved therein (see Appendix C). Timeline A timeline will be used to assist with implementing this project, as collaboration with educators is required to launch it. To begin, a meeting will be initiated to define the project scope and objectives with staff and educators who will be participating. During this time, deliverables will be presented to staff and educators involved in its presentation. Dates of the project launch will also be discussed as they may vary depending on the educators' schedules. Once this date is secured, the educators will email all deliverables to all applicable students. A two-week deadline will be included by which all participating students should complete the first two deliverables, 18 the pre-assessment survey and the learning module. At this time, the pre-assessment surveys will be reviewed for information and statistics. Four weeks after the due date for the first portion has passed, the post-assessment survey will be emailed to the students so they can complete and submit it within two weeks. This project proposes roughly twelve weeks or three months. This time frame will allow for planning, implementation, and project evaluation (Appendix D). The project will implement a teaching module to improve the competence of healthcare provider students in assessing pressure injuries in dark-complected patients. The proposed timeline outlines the critical steps from project initiation to evaluation to enhance knowledge and skills in pressure injury assessment for this specific patient population. By following this timeline, we intend to create an inclusive educational experience that aligns with the literature review findings and addresses the identified educational gaps. Project Evaluation Evaluation is essential for assessing the project's effectiveness, impact, and value in improving competence in pressure injury assessment for dark-complected patients. It provides valuable insights for continuous improvement, accountability, and evidence-based decisionmaking, ultimately advancing healthcare education and practice. (Galas et al., 2017). To evaluate the project's effectiveness and before implementing the teaching module, a pre-assessment survey will be administered to students to gauge their baseline knowledge and understanding of pressure injury assessment in dark complexions. This survey will help identify areas of weakness and inform the development of targeted educational materials. After the teaching module, the post-assessment survey will be administered to students to assess their knowledge retention and understanding. This survey will include questions similar to those in the pre-assessment quiz but will cover material learned throughout the module. 19 After all participants complete the post-assessment survey, a student feedback survey will be administered. These surveys will include Likert-scale questions to measure students' satisfaction with the educational materials and teaching strategies and open-ended questions to gather qualitative feedback on the overall effectiveness of the module. After all feedback has been received, it will be used to update and improve future modules. Ethical Considerations This project's ethical principles guide every aspect, ensuring social responsibility, nondiscriminative behaviors, and respect for diversity. Ethics are the focus for conducting valid and meaningful research (Clark, 2019). The focus on pressure injury assessment in dark-complected patients underscores a commitment to addressing healthcare disparities and promoting inclusivity in education and practice. All project materials and interactions are crafted to be free from bias or discrimination based on race, ethnicity, or skin color. Central to the ethical framework is transparency. Participants will be fully informed about participation's purpose, procedures, and potential risks and benefits, with the assurance of the right to withdraw at any time without repercussions. Measures are in place to safeguard the privacy and confidentiality of participants' information and collected data, ensuring secure storage and limited access to authorized personnel. The potential for data loss, theft, and unintended consequences will be mitigated because no personal data will be collected (Sala, 2016). Respect for participants is paramount, with their perspectives and feedback valued and their dignity upheld throughout the project. Any concerns or complaints raised by participants are promptly addressed with sensitivity and transparency. Additionally, efforts are made to 20 ensure inclusivity and accessibility in project materials and activities, accommodating any special needs or accommodations requested by participants. Ethical research practices are upheld in all aspects of the project, including the design, implementation, and dissemination of findings. Rigorous standards of honesty, integrity, and transparency guide the research process, fostering trust and credibility in the outcomes (CDC, 2017). Furthermore, the project adheres to principles of scientific integrity, ensuring accuracy, reliability, and validity in data collection, analysis, and interpretation. Overall, this project seeks to advance knowledge and skills in pressure injury assessment and exemplifies a commitment to ethical conduct in research and education. By upholding ethical principles, the project promotes equitable and inclusive healthcare practices, benefiting individuals and communities. Discussion This project holds significant implications for advancing nursing practice by addressing the need for improved competence in pressure injury assessment for dark-complected patients. Implicit bias and lack of education increase the chances of poor health outcomes for those with dark complexions (Hall et al., 2015). By providing targeted education and training, the project aims to enhance the skills and knowledge of healthcare provider students, ultimately improving patient outcomes and reducing healthcare disparities. Evidence supports the importance of culturally sensitive healthcare practices in addressing the needs of diverse patient populations, and this project aligns with recommendations for inclusive education to promote equitable healthcare delivery (Tadesse et al., 2023). Dissemination 21 In addition to the "3 Ps" of dissemination—poster, podium, and publication—several other methods can be employed to share significant project findings. One approach is to host workshops or webinars where information regarding the lack of information of care for those with dark complexions can be presented to a broader audience of healthcare professionals, educators, and researchers. These interactive sessions facilitate in-depth discussions and knowledge sharing. Another avenue is to present these findings at local, national, or international conferences relevant to healthcare education or nursing practice. Conference presentations offer valuable networking opportunities and exposure to a diverse audience. Submitting project findings for publication in nursing newsletters, journals, or other professional publications is another effective dissemination strategy. This allows for broader dissemination of research findings and contributes to the scholarly literature in healthcare education. Another strategy will present this vital information to a broader audience by leveraging social media platforms and online forums to share project summaries, key findings, and relevant resources. Engaging with online communities would enable real-time interaction and feedback. Lastly, collaborating with healthcare organizations, professional associations, and academic institutions to integrate the findings of this project into ongoing educational initiatives or practice guidelines would promote knowledge translation and facilitate the uptake of evidence-based practices in healthcare settings. Significance to Advanced Nursing Practice This project holds significant potential to benefit the nursing profession in several ways. Firstly, by addressing the educational gap in pressure injury assessment for dark-complected patients, the project aims to enhance the competence and preparedness of healthcare provider students, thereby improving patient care outcomes (Kim et al., 2020). This aligns with the 22 nursing profession's commitment to providing high-quality, culturally sensitive care to diverse patient populations. This project benefits the nursing profession by promoting equity in healthcare delivery. Research has consistently shown that individuals with darker skin tones are at higher risk of experiencing disparities in healthcare access and outcomes. By focusing on pressure injury assessment in dark-complected patients, this project addresses these disparities and works towards achieving healthcare equity for all patients. Furthermore, enhancing competence in pressure injury assessment aligns with the nursing profession's emphasis on evidence-based practice and patient safety. Pressure injuries are a significant healthcare concern associated with increased morbidity and mortality, particularly in vulnerable patient populations (European Pressure Ulcer Advisory Panel, 2019). By improving healthcare provider students' ability to assess and manage pressure injuries accurately, this project contributes to preventing and managing these adverse events, ultimately improving patient outcomes and enhancing the quality of nursing care. Implications Several strengths and limitations have been identified in this project. One strength of this project lies in its targeted approach to addressing a specific educational gap in healthcare provider education, namely pressure injury assessment in dark-complected patients. By focusing on this specific issue, the project aims to improve competence and preparedness among healthcare provider students, ultimately enhancing patient care outcomes and promoting equity instead of color-blindness in healthcare delivery (Oozageer et al., 2020). Additionally, the project's emphasis on interactive learning strategies, integration of multimedia resources, and 23 longitudinal follow-up assessments adds depth and rigor to the educational intervention, enhancing its overall effectiveness and impact. However, a limitation of the project may lie in its potential resource constraints, including limitations in funding, time, and access to technology or educational resources. These constraints may affect the scope and scale of the project, limiting its ability to reach a broader audience or sustain long-term implementation. Additionally, challenges in engaging stakeholders, addressing logistical barriers, and navigating institutional policies and procedures may pose obstacles to project implementation. Despite these limitations, proactive efforts to mitigate challenges and adapt strategies based on feedback and evaluation findings can help strengthen the project's impact and effectiveness over time. Recommendations Recommendations for enhancing this project include soliciting feedback from faculty, content experts, and peers to identify areas for improvement and refine educational materials and strategies. Additionally, collaborating with experts in cultural competence, implicit bias, and pressure injury assessment to ensure the relevance and effectiveness of the educational content is crucial. Additional assessment methods, such as patient simulations or case studies, could enhance students' practical skills and prepare them for real-world scenarios. Furthermore, conducting further research to explore barriers to pressure injury assessment in dark-complected patients and evaluating the long-term impact of the educational intervention on patient outcomes would help fill gaps in knowledge and encourage future educational initiatives. Addressing these recommendations will strengthen the project's effectiveness and contribute to advancing healthcare provider education in medical assessments for diverse patient populations. Conclusions 24 Medical professionals, nurses, and nurse assistants are crucial to improving healthcare outcomes. This project has achieved significant outcomes through a comprehensive literature review and developing an educational intervention to improve competence in pressure injury assessment for dark-complected patients among healthcare provider students. The literature review identified gaps in current educational practices and highlighted the importance of addressing disparities in healthcare delivery for diverse patient populations. By analyzing evidence from various sources, the project informed the development of targeted educational materials and strategies tailored to the specific needs of dark-complected patients. Key findings from the literature review underscored the importance of cultural competence, the impact of structural racism on healthcare disparities, and the need for innovative approaches to enhance pressure injury assessment skills among healthcare providers. The project aims to address these findings by implementing evidence-based solutions, collaborating with stakeholders, and advocating for equity in healthcare delivery. Overall, the project contributes to advancing nursing practice by promoting culturally sensitive care and addressing healthcare disparities in assessments. 25 References Bates-Jensen, B. 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Critical Care Nursing Clinics of North America, 13(4), 497–509. https://doi.org/10.1016/S08995885(05)70306-9 29 Appendix A Pre-assessment Survey https://app.emaze.com/@ALLFTLCQT/pre-modulesurvey 30 Appendix B Learning Module: Reducing Pressure Injuries in Dark Complected Individuals https://www.emaze.com/@ALLFTLLQO/reducing-acute-presure-injuries-in-darkcomplexions?autoplay 31 Appendix C Post-learning Module Assessment https://app.emaze.com/@ALLFTLZRI/pressureinjuryindarkcomplexionspostmodulesurvey 32 Appendix D